Liver transplantation without venovenous bypass: Morbidity and mortality in patients with greater than 50% reduction in cardiac output after vena cava clamping

Abstract

Objective: To investigate whether a decrease in cardiac output of ≥50% after vena cava clamping is associated with an increase in perioperative morbidity or mortality in patients undergoing orthotopic liver transplantation without venovenous bypass. Design: Retrospective, clinical study. Participants: Patients undergoing elective orthotopic liver transplantation without venovenous bypass (n = 172). Interventions: None. Measurements and Main Results: In 82 patients (group 1), the decrease in cardiac output after vena cava clamping was ≥50%; in 90 patients (group 2), the decrease was <50%. Hemodynamics during surgery and perioperative morbidity and mortality were compared between group 1 and group 2 patients. Mean arterial pressure during the anhepatic phase was not significantly different between groups, but cardiac output and mixed venous oxygen saturation were significantly lower in group 1 patients. Perioperative mortality, need for postoperative renal replacement therapy, postoperative serum creatinine levels, and graft function were not different between groups. Conclusion: A >50% reduction in cardiac output after vena cava clamping is not associated with an increase in perioperative morbidity and mortality when compared with patients with a less pronounced reduction in cardiac output. These results question the common practice of basing the indication for venovenous bypass during the anhepatic phase on a reduction in cardiac output of >50% after a trial of vena cava clamping. Copyright © 2001 by W.B. Saunders Company